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May 2019

Avoidance better than oral immunotherapy for peanut allergy



Peanut allergy oral immunotherapy increases the risk of allergic reactions, compared with avoidance or placebo, according to a study in The Lancet.

Despite effectively inducing desensitisation in the clinic, oral immunotherapy for peanut allergies appears to increase allergic and anaphylactic reactions significantly, compared with avoidance or placebo. The findings highlight the gap between outcomes measured in the clinic and allergy relief in the real world.

Studies of oral immunotherapy currently measure treatment success by whether a treated patient can pass a supervised food challenge, but this cannot predict a patient’s future risk and frequency of allergic reactions in the real world. The study authors call for a new approach to food allergy research to focus on real-world outcomes and everyday exposures.

Food allergy is common problem, affecting up to 8% of children and 2-3% of adults. Although allergy to milk and egg are often outgrown in childhood, peanut allergy is lifelong in 80-85% of cases. The potentially life-threatening nature of food allergic reactions is associated with substantial anxiety and impaired quality of life for patients. There is no treatment for allergies, other than avoidance and medication to treat allergic reactions or anaphylaxis.

Immunotherapy is an investigational therapy for allergies that involves repeated exposure over time to gradually increasing doses of the allergen, with the aim of reducing allergic reactions. While other forms of immunotherapy (sublingual or subcutaneous) for other allergies appear safe and effective in randomised controlled trials, the outcomes of oral immunotherapy are debated.


Chu D, et al. The Lancet, 25 April 2019.

www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30420-9/fulltext